Costanza M E, Greene H L, Zapka J G, Barth R S, D'Orsi C J, Wertheimer M D
Department of Medicine, UMass Medical School, Worcester 01655.
Prog Clin Biol Res. 1989;293:65-74.
Our 3 Step Primary Care Program is apparently successful. The first year program focused on 3 types of intervention: 1. Interventions to influence reinforcing factors (i.e. finding rapport among significant community leaders) 2. Interventions to alter predisposing factors (i.e. presenting informative material in a palatable memorable form) 3. Interventions to enable physicians to make change (through an innovative program of patient instructors and office practice changes). Next year's program will include reinforcing and enabling strategies: a repeat patient instructor encounter in the doctor's office and a more intensive office practice intervention. Final evaluation of the success of our physician intervention awaits completion of the program and evaluation of the change in breast health counselling, in the practice of breast physical exam and in the number of routine screening mammograms performed in this community.
我们的三步初级保健计划显然很成功。第一年的计划侧重于三种干预措施：1. 影响强化因素的干预措施（即与重要社区领袖建立融洽关系）；2. 改变诱发因素的干预措施（即以易于接受且令人难忘的形式提供信息材料）；3. 使医生能够做出改变的干预措施（通过患者指导创新计划和办公室实践变革）。明年的计划将包括强化和促成策略：在医生办公室再次安排患者指导会面，以及更深入的办公室实践干预。对我们医生干预措施成功与否的最终评估，有待该计划完成，以及对该社区乳房健康咨询的变化、乳房体格检查的实践情况和常规筛查乳房X光检查的数量进行评估。
